approach to Bleeding during pregnancy
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simple explanation about causes of bleeding in early pregnancy
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approach to Bleeding during pregnancy
- 1. Bleeding during pregnancy T.M Farouk tarek
- 3. Bleeding< 20 wks 1st speculum To rule out local lesions Cervix open Cervix closed Snow storm appearance Molar pregnancy Incomplete abortion Inevitable abortion D & C Emergency suction
- 4. Cervix closed Vaginal U / S Intrauterine pregnancy Threatened abortion Bed rest No IUP Ectopic pregnancy B-hCG quantative < 1500 > 1500 Wait 2 days & repeat B-hCG Ectopic pregnancy unruptured ruptured Amenorrhea , bleeding & unilateral pain Sever bleeding , HR , Bp , + guarding & rigidity Non viable pregnancy without vaginal bleeding , cramping or cervical dilatation Missed abortion
- 5. 1- Miscarriage • Bleeding is a sign of miscarriage, but does not mean that miscarriage is imminent. • 20-30% of women have degree of bleeding in early pregnancy. • Approximately half of pregnant woman who bleed do not have miscarriages. • 15-20% result in a miscarriage, and occur during the first 12 weeks.
- 6. It is probably miscarriage if there are : • Vaginal bleeding. • Cramping pain stronger than menstrual cramps. • Tissue passing through the vagina. Most miscarriages can not be prevented. Miscarriage does not mean that woman can not have a future healthy pregnancy or she is not healthy
- 7. 2- Ectopic pregnancy • Implantation occurs somewhere out side the uterus.fallopian tube accounts for the majority of ectopic pregnancies. • Less common than miscarriages, occurring in 1 of 60 pregnancies.
- 8. It is probably ectopic pregnancy if there are : • Severe pain in the abdomen. • Low level of hCG. • Vaginal bleeding Woman at high risk if they have :- Infection in the tube Previous ectopic pregnancy (15-20%) Previous pelvic surgery
- 9. 3- Molar pregnancy : • Rare cause of early bleeding. • Term molar because pregnancy involves the growth of abnormal tissue instead of an embryo.
- 10. It is probably molar pregnancy if there are • Vaginal bleeding. • High hCG levels. • Absent fetal heart tones. • Grap-like clusters are seen in the uterus by an ultrasound.